Otolaryngology Coding Alert

Question: My doctor states that he did both anterior and posterior packing for epistaxis on the patient’s right nostril. Would I code for both anterior and posterior with 30901 and 30905 or would I just code for the posterior?

Indiana Subscriber

Answer: Because the Correct Coding Initiative (CCI) bundles codes 30901 (Control nasal hemorrhage, anterior, simple [limited cautery and/or packing] any method) and 30903 (Control nasal hemorrhage, anterior, complex [extensive cautery and/or packing] any method) into 30905 (Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial), you should submit only one same-side hemorrhage-control code for each encounter. If your otolaryngologist documents that he performs anterior and posterior packing, report only 30905.

If the documentation indicates that the two procedures took an extraordinary amount of time beyond the normal time for these procedures or was complicated (perhaps because this patient was on long term anti-coagulants [coded Z79.01], etc.), you can add a 22 modifier (Increased procedural services) for an increased service to the 30905 and increase your fee when submitting your claim. You probably will not receive the additional monies when you are first paid and will have to appeal using the documentation that indicates the complexity of the case to get additional monies from the third party payer. The additional payment will all hinge on the quality of your doctor’s documentation.